Abstract
BackgroundAccess to and utilization of adolescent sexual and reproductive health (ASRH) services remains poor. ASRH services in Kenya are primarily offered in health facilities and include counselling, information, and services on family planning, sexually transmitted infections, and HIV and basic life skills. The Ministry of Education also provides age-appropriate sexual and reproductive health information in schools. This paper presents a study protocol that will evaluate the effectiveness of a combined approach toward improving utilization of ASRH services.MethodsThis will be a quasi-experimental study utilizing qualitative and quantitative methods. During the formative phase, data will be collected through focus group discussions, in-depth interviews, and key informant interviews to explore the barriers and facilitators of provision and utilization of ASRH services. A quantitative design will be used to obtain baseline and endline data through household surveys and client exit interviews. Following the formative and baseline household and client exit assessments, an intervention focusing on provision of ASRH service package targeting boys and girls will be implemented for 18 months. The package will include contextualized ASRH services, including counselling and age-appropriate, comprehensive sexual education for behavior change with an aim to increase utilization of ASRH services. An analysis of the primary outcome (utilization of ASRH services) will be undertaken to establish the difference in difference between the control and intervention arm, before the intervention (using the baseline survey data) and after the intervention (using the endline survey data).DiscussionAdolescents have now been included in the World Health Organization’s Global strategy for women’s, children’s and adolescents’ health (2016–2030), acknowledging the unique health challenges facing young people and their pivotal role as drivers of change in the post-2015 era. This study will generate evidence on whether a combined school, facility, and community approach works toward improving utilization of ASRH services. The information generated from the study will be beneficial for programming as it will identify underlying reasons for low utilization of ASRH services. Results will help to shape ASRH programs and reduce teenage pregnancy within Kenya and other similar low middle-income countries.Trial registrationThe study is registered at http://www.pactr.org/, registration number PACTR201906738029948.
Highlights
Access to and utilization of adolescent sexual and reproductive health (ASRH) services remains poor
A review of best practices used in adolescent SRH (ASRH) programs established that many ASRH interventions are implemented in an uncoordinated and piecemeal fashion, they do not result in positive outcomes for adolescents [3]
We present a protocol to evaluate the effectiveness of this model in Kisumu and Kakamega counties, which have some of the highest burden of teen pregnancy in Kenya, at 22 and 15% consecutively [9]
Summary
Access to and utilization of adolescent sexual and reproductive health (ASRH) services remains poor. This paper presents a study protocol that will evaluate the effectiveness of a combined approach toward improving utilization of ASRH services. Adolescents and youth are referred to as young people, encompassing the ages of 10– 24 years. There is a gap in adolescents’ access to sexual and reproductive health (SRH) services and information, which has not been fully addressed. Several studies have assessed what works to increase access and utilization for SRH among young people. There is, a lack of scientifically sound data on the effectiveness of services that target young people in sub-Saharan Africa, especially in comparison to the magnitude of adolescent SRH (ASRH) challenges in the region [2]. A review of best practices used in ASRH programs established that many ASRH interventions are implemented in an uncoordinated and piecemeal fashion, they do not result in positive outcomes for adolescents [3]
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